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Biomedical subjects

P Kissinger

Publications and source records attributed to P Kissinger.

At least 37 records · Page 2Linked to original sources
PubMed1999

Networks of persons with syphilis and at risk for syphilis in Louisiana: evidence of core transmitters.

BACKGROUND AND OBJECTIVES: Differences in sociodemographic attributes and healthcare access may explain differences in regional sexually transmitted disease rates but don't fully explain why syphilis persists disproportionately in certain populations. GOAL OF THIS STUDY: To understand the behavioral epidemiology of syphilis, we conducted a social network analysis of persons with syphilis and their contacts and developed and applied a definition of core transmitters. STUDY DESIGN: We interviewed 10 index persons with primary or secondary untreated syphilis and 80 of their named sexual and social contacts. RESULTS: Fourteen (16%) of 90 interviewed persons met the definition of core transmitters, 9 of whom had past or current syphilis. The other interviewed persons had only moderately risky behaviors. Seventy-eight (42%) of the network sexual contacts were connected directly or indirectly to a core transmitter. CONCLUSION: This analysis suggests that syphilis transmission is maintained by a community with a small percentage of high-risk persons centrally placed amidst a larger group with moderately risky behavior.

Adult↗
PubMed1999

Natural history of intestinal microsporidiosis among patients infected with human immunodeficiency virus.

A chart review of 73 human immunodeficiency virus (HIV)-infected patients with enteric microsporidiosis was conducted to define the natural history of microsporidiosis. A substantial proportion of patients remained symptomatic after 6 months (54.8% with persistent diarrhea and 51.2% with weight loss). Predictors for persistent diarrhea included high HIV RNA viral load and no initiation of protease inhibitor therapy.

AIDS-Related Opportunistic Infections↗
PubMed1999

Characteristics of HIV-infected men with low serum testosterone levels.

Low levels of serum testosterone may have negative implications on morbidity in HIV-infected men. The purpose of this study was to determine demographic and clinical characteristics that predict low serum testosterone among men attending our HIV clinic. A cross-sectional study of 587 HIV-positive male patients who presented at the Louisiana State University HIV Outpatient (HOP) Clinic between August 1997 and January 1999 was conducted. Demographic and clinical characteristics were collected and analysed. Of the 587 men studied, 119 (20.3%) had a serum testosterone level below 400 ng/dl. Significantly more men with low serum testosterone levels had a presence of opportunistic infection (especially HIV wasting syndrome, oesophageal candidiasis, or dementia), CD4+ cell counts below 200 cells/mm3, or were taking megestrol acetate. Early detection of low serum testosterone will allow for expedient testosterone supplementation therapy, which could improve morbidity and quality of life for HIV-infected men.

AIDS Dementia Complex↗
PubMed1999

Elevation of serum riboflavin carrier protein in breast cancer.

Presently available tumor markers have had a limited clinical impact. Riboflavin carrier protein (RCP) is an estrogen inducible protein that occupies a key position in riboflavin metabolism. Because other vitamin carrier proteins (VCP) have been shown to be overexpressed in patients with malignant disease, we evaluated serum RCP levels in patients with adenocarcinoma of the breast. In this prospective blinded study, patients with breast cancer, benign breast disease, and healthy controls were analyzed for RCP levels. Using a highly sensitive RIA, we observed that serum RCP levels were significantly elevated in women with breast cancer (n = 52) as compared with control subjects [n = 50; 6.06 +/- 7.27 ng/ml versus 0.70 +/- 0.19 ng/ml (mean +/- SD), respectively; P < 0.0001]. A serum RCP level of > or = 1.0 ng/ml was highly predictive of the presence of breast cancer, detecting 88% of tumors in stages I-II and 100% of tumors in stages III-IV. Overall, this RCP assay has a sensitivity of 92.3%, a specificity of 88%, a positive predictive value of 88.9%, and a negative predictive value of 91.7%. These results show increased serum levels of RCP in breast adenocarcinoma patients and suggest that RCP levels may be useful as a new marker for breast cancer. The positive predictive value in early-stage breast cancer suggests that the RCP assay may be a useful adjunct to present screening technology.

Adenocarcinoma↗
PubMed1999

HIV sinusitis: rationale for a treatment algorithm.

Over 12 million individuals worldwide are infected with the human immunodeficiency virus (HIV). Up to 60% of these persons may suffer from disease of the paranasal sinuses. Numerous differences exist between sinusitis in HIV and non-HIV infected patients. Some of the differences include HIV sinusitis pathogenesis, bacteriology, and management. This paper addresses these issues so that physicians may adequately prevent, diagnose, and treat persons suffering from HIV sinus infection.

AIDS-Related Opportunistic Infections↗
PubMed1998

Pregnancy is not associated with the progression of HIV disease in women attending an HIV outpatient program.

The objective of this study was to determine whether pregnancy is associated with an acceleration of human immunodeficiency virus (HIV) disease progression in women who have a pregnancy while HIV infected. A retrospective review of all women aged 15-35 years who attended an HIV outpatient program from January 1989 through August 1995, was undertaken. The 192 women who had a term pregnancy after testing positive for HIV were compared with 164 women who were not pregnant during the same period. The main outcome measures were death, the occurrence of a first acquired immunodeficiency syndrome (AIDS)-defining condition, or a condition indicative of symptomatic HIV. Disease progression was assessed using the Kaplan-Meier method and multivariate proportional hazards models. Compared with nonpregnant women, women with a term pregnancy were significantly more likely to be African-American (88% vs. 78%, p < 0.05), younger than 22 years of age (51 % vs. 11%, p < 0.001), and to have entered the clinic with a higher median CD4 count (519 vs. 433 cells/microl, p < 0.001). After adjusting for entry CD4 count and other factors, pregnancy was not associated with progression to any of the study outcomes. Thus, in women attending a publicly funded clinic, pregnancy does not appear to accelerate the progression of HIV disease.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Reproductive choices among HIV-positive women.

The objective of this study was to describe the characteristics of HIV-positive women who become pregnant, who choose to get sterilized, and who have an elective abortion after an HIV diagnosis. All HIV-infected women between the ages of 14 and 35 years (N = 403) who were enrolled in the HIV Outpatient Program in New Orleans, U.S.A., between 1987 and 1995 were included in the study. Medical records were abstracted for reproductive outcomes and demographic and medical characteristics. The mean age of the participants was 25.8 years, 83% were African American, 71% were single, 20% had a history of i.v. drug use, and 35% had a history of non-i.v. drug use at entry. Mean follow-up time was 2.9 years. The overall incidence of pregnancy subsequent to HIV diagnosis was 6.3% per person-year of observation. Twenty-four percent of the population underwent a sterilization procedure subsequent to HIV diagnosis, and 25% of the women who became pregnant subsequent to diagnosis had an induced abortion. Factors associated with subsequent pregnancy in multivariate analysis included young age and a history of sexual assault. Factors associated with subsequent sterilization in multivariate analysis were CD4 count over 200, having one or more living children, and not living with a family member. Factors associated with subsequent abortion included being White and non-single. Sexual assault history and living with a sex partner were associated with abortion at the p < 0.1 level. The study concludes that HIV-infected women tend to have lower rates of pregnancy and higher rates of sterilization and abortion than their uninfected counterparts. Counseling messages that are culturally sensitive, non-coercive, and that take into consideration the complexities of the decision-making process should be standardized for all HIV-infected women so that they can make informed decisions.

Abortion, Induced↗
PubMed1998

The clinical profile of end-stage AIDS.

The purpose of this study was to describe the clinical profile of end-stage AIDS in patients 12 months before death. A cross-sectional examination of HIV-infected patients who attended a public HIV outpatient clinic between 1990 and 1996 and who died was conducted. The prevalence and first-time acquisition of AIDS-defining conditions 12 months before death were evaluated. The AIDS-defining conditions with the highest percentages of first-time acquisition in the last 12 months of life were progressive multifocal leukoencephalopathy (100%), lymphoma (96%), dementia (78.6%), Mycobacterium avium complex (MAC) infection (74.0%), toxoplasmosis (72.6%), and cytomegalovirus (CMV) infection (69.6%). Of the concomitant conditions studied, those with the highest percentages of first-time acquisition in the last 12 months of life were CMV with MAC (99%) and CMV with wasting (88%). Patients who acquire these AIDS-defining conditions may be eligible to receive information about end-stage options, such as hospice care. However, administration of aggressive antiretroviral treatments, such as the protease inhibitors, may affect this profile in the future, as the majority of the patients in this study were receiving the standard antiretroviral treatments of the time, primarily zidovudine.

AIDS-Related Opportunistic Infections↗
PubMed1998

Effectiveness of patient delivered partner medication for preventing recurrent Chlamydia trachomatis.

OBJECTIVE: To determine if providing Chlamydia trachomatis infected women with medication to deliver to their sex partner(s) could reduce recurrent chlamydia infections compared with the standard partner referral method. STUDY DESIGN: A observational cohort study of 178 women, 14-39 years old attending a family planning clinic, diagnosed and treated for C trachomatis between October 1993 and December 1994 was conducted (43 received patient delivered partner medication (PDPM) and 135 received partner referral cards). Women were retested before or at their annual visit. RESULTS: The mean time of follow up was 17.7 months (SD 7.7). The PDPM group (n = 43) was similar to partner referral group (n = 135) for age, race, contraceptive method, history of an STD, and follow up time. The annual recurrent infection rate was lower among the PDPM group compared with the partner referral group (11.5% v 25.5%, p < 0.05). After adjusting for age in logistic regression, women in the PDPM group were less likely than women in the partner referral group to have an incident C trachomatis infection (OR 0.37, 95% CI 0.15-0.97, p < 0.05). CONCLUSION: These findings suggest that patient delivered partner medication can protect women from recurrent C trachomatis infection compared with the standard partner referral approach. Prospective studies with larger sample sizes are under way.

Adolescent↗
PubMed1997

Retroviral coinfections at a New Orleans HIV outpatient clinic.

The purpose of the study was to determine the seroprevalence of human T-lymphotropic virus types I and II (HTLV-I and HTLV-II) infections in an outpatient clinic population of human immunodeficiency virus (HIV)-1 infected persons as well as to identify the demographic and clinical characteristics and laboratory results associated with HTLV-I/II infections. During 1993-1995, 854 patients were tested for HTLV-I/II infection on entry into the clinic, of whom 25 were infected with HTLV-I and 35 with HTLV-II. Multivariate analysis revealed that patients with coinfections were more likely to be black, aged over 35 years, and have a history of injection drug use. HIV-1/HTLV-I coinfections were associated with higher median CD8 counts on entry (p < 0.05), and HIV-1/HTLV-II coinfections were associated with higher median percent CD4 counts (p < 0.05) compared with patients infected with HIV only. Coinfection was not associated with an increased diagnosis of AIDS. These findings indicate that HIV-1/HTLV-I/II coinfections are frequently diagnosed and are associated with unique immune phenotypes. Given the lack of information regarding the influence of dual infection on clinical status, differentiation of HTLV-I from HTLV-II infections may be important in understanding the clinical significance of retroviral coinfections.

Adult↗
PubMed1997

Determination of factors associated with condom use among women infected with human immunodeficiency virus.

To better understand potential barriers to condom use and the sexual behaviour of women infected with human immunodeficiency virus (HIV), an anonymous self-administered survey was performed on a convenience sample of 83 predominantly single HIV+ women. Most women had only one sexual partner who usually knew of the subject's serostatus. Only a minority of partners (26%) were known to also be HIV infected. Subjects were surprisingly more likely to use condoms with their main partner as opposed to other partners. Factors found to be associated with condom non-use included younger age, low education level, partner HIV+, history of a sexually transmitted disease (STD), and use of drugs or alcohol during sex. Although most subjects indicated the decision was mutual when deciding not to use a condom, 20% stated it a was a partner decision. Future intervention efforts should target these identified high-risk individuals and optimally involve the partners of HIV-infected women.

Adolescent↗
PubMed1997

History of sexual abuse among HIV-infected women.

The objective of this study is to describe the characteristics associated with a history of sexual abuse among HIV-infected women enrolled in a public inner-city HIV outpatient clinic. A retrospective chart review of 238 women of childbearing age enrolled in the HIV outpatient clinic between 1987 and 1995 was performed. Characteristics of the study population were 83% African American, 69% single, and 53% finished high school or were still in school. The mean age was 25.7 years. Of the 238 women, 32% had a history of sexual abuse. Factors associated with sexual abuse history after controlling for age included living in a non-permanent situation (OR=4.8), history of non-intravenous drug use (OR=4.65), and having dropped out of school (OR=2.2). HIV-infected women should be screened for a history of sexual abuse and carefully counselled regarding their reproductive choices and drug treatment.

Adolescent↗
PubMed1997

An evaluation of initiatives to improve family planning use by African-American adolescents.

Teen pregnancies in the United States have reached epidemic proportions, and consequently, efforts to promote family planning among adolescents have increased. At the Orleans Parish Family Planning Clinic in New Orleans, Louisiana, adolescent-specific initiatives were implemented to improve understanding of family planning services and promote contraceptive use. Since 92% of the patients are African American, the study population was limited to this group. This study examines the efficacy of two initiatives (i.e., orientation sessions and 3-month booster visits conducted in adolescent-specific clinics) for improving initiation and continuation of family planning services among African-American adolescent women. Initiation of services was compared among those who attended the orientation session and those who did not attend. Continuation of services was determined by attendance of the annual visit for those who attended the 3-month follow-up visit and those who did not attend. Of 737 teens entering into the clinic, the mean age was 16 years, 95% were enrolled in school, 23% attended the orientation session, and 71% initiated services. Of the 507 who initiated services and who underwent follow-up for at least 12 months, 29% attended the 3-month follow-up visit and 32% attended an annual visit. Attendance of the orientation session was associated with initiation of services and attendance of the 3-month booster visits was associated with attendance of the annual visit in multivariate logistic regression. Simple and cost-effective techniques such as orientation sessions and follow-up visits conducted in adolescent clinics can improve initiation of family planning and compliance among adolescents.

Adolescent↗
PubMed1997

Nicotine addiction and smoking cessation.

Cigarette smoking remains the greatest threat to public health in our society and is responsible for one of every five deaths in the United States. While the prevalence of smoking has declined dramatically over the past 30 years, over 26% of Americans continue to smoke. In Louisiana, one third of adult men and one quarter of adult women smoke. The irony of this problem is that smoking is a modifiable behavior. To better counsel their patients regarding smoking cessation, health care practitioners should be aware of the health risks of smoking, the benefits of smoking cessation, and therapies available to assist their patients in breaking the habit. This article reviews the current literature and addresses these issues.

Adult↗